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ARQGA/1179
PANCREATECTOMIA DISTAL
VIDEOLAPAROSCPICA
EM PACIENTES COM
CISTADENOMA DE PNCREAS
Marcel Autran C. MACHADO, Leonardo F. CANEDO, Paulo HERMAN,
Andr L. MONTAGNINI, Rubens A. A. SALLUM e Marcel Cerqueira Cesar MACHADO
RESUMO Racional - O diagnstico de tumores csticos do pncreas vem aumentando nos ltimos anos. Estes tumores acometem
geralmente pacientes do sexo feminino e apresentam poucos sintomas. Sua remoo por videolaparoscopia est indicada
em pacientes selecionadas, principalmente quando localizados na regio distal do pncreas. Objetivos - apresentada a
experincia inicial de um grupo de cirurgies na realizao de pancreatectomia distal por videolaparoscopia em pacientes com
cistadenoma pancretico. Material e Mtodos - Trs pacientes do sexo feminino (idade mdia, 55 anos) foram submetidas a
resseco pancretica por videolaparoscopia entre setembro de 2001 e dezembro de 2003. Resultados - A resseco pancretica
por videolaparoscopia foi realizada com sucesso nas trs doentes. O tempo cirrgico variou de 4 a 6 horas. O sangramento
operatrio foi mnimo em todos os casos. A aplicao do grampeador endoscpico foi difcil em uma paciente devido espessura
do pncreas. As trs pacientes evoluram bem, recebendo alta entre o 2o e o 5o dia ps-operatrio. Duas apresentaram fstula
pancretica com resoluo aps tratamento conservador. Concluses - A pancreatectomia laparoscpica factvel, pode trazer
benefcios aos pacientes portadores de neoplasia cstica da poro distal do pncreas, com pouca dor ps-operatria, curto
tempo de permanncia hospitalar, baixo ndice de complicaes e melhor resultado esttico.
DESCRITORES Pancreatectomia. Neoplasias pancreticas, cirurgia. Cistadenoma. Laparoscopia.
INTRODUO
Arq Gastroenterol
157
Machado MAC, Canedo LF, Herman P, Montagnini AL, Sallum RAA, Machado MCC. Pancreatectomia distal videolaparoscpica em pacientes com cistadenoma de pncreas
158
Arq Gastroenterol
Machado MAC, Canedo LF, Herman P, Montagnini AL, Sallum RAA, Machado MCC. Pancreatectomia distal videolaparoscpica em pacientes com cistadenoma de pncreas
Arq Gastroenterol
159
Machado MAC, Canedo LF, Herman P, Montagnini AL, Sallum RAA, Machado MCC. Pancreatectomia distal videolaparoscpica em pacientes com cistadenoma de pncreas
Machado MAC, Canedo LF, Herman P, Montagnini AL, Sallum RAA, Machado MCC. Laparoscopic distal pancreatectomy for pancreatic
cystadenomas. Arq Gastroenterol 2005;42(3):157-60.
ABSTRACT Background - Cystic neoplasms are an uncommon group among pancreatic tumors. These lesions are seen more frequently in
recent surgical practice, probably because of advances in diagnostic and surgical techniques. Total tumor resection provides the best chance
of cure and may remove the risk of malignant transformation of the cystadenomas, particularly of the mucinous type. Minimally invasive
techniques have been revolutionary and provide clinical evidence of decreased morbidity and comparable efficacy to traditional, open surgery.
However, laparoscopic pancreatic resection is not an established treatment for tumors of the pancreas. Aim - The authors present their initial
experience with laparoscopic distal pancreatectomy for pancreatic cystadenomas. Material and Methods - Three female patients (mean age,
55 years) underwent laparoscopic pancreatic resection between September 2001 and December 2003. Results - Laparoscopic pancreatic
resection was successfully performed in all patients. Operative time varied between 4 and 6 hours. Intraoperative bleeding was minimal.
Due to a thick pancreas, the application of vascular endoscopic stapler was difficult in one patient. Two patients presented postoperative
pancreatic leakage with spontaneous resolution. Conclusions - Resection of the pancreas can be safely performed via the laparoscopic
approach with all the potential benefits to the patients of minimally invasive surgery.
HEADINGS Pancreatectomy. Pancreatic neoplasms, surgery. Cystadenoma. Laparoscopy.
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Arq Gastroenterol
Recebido em 30/9/2004.
Aprovado em 15/4/2005.